Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island

Zang, Xiao; Macmadu, Alexandria; Krieger, Maxwell S.; Behrends, Czarina N.; Green, Traci C.; Morgan, Jake R.; Murphy, Sean M.; Nolen, Shayla; Walley, Alexander Y.; Schackman, Bruce R.; Marshall, Brandon D. L.

doi:10.1016/j.drugpo.2021.103435

Cited by 20 publications

(18 citation statements)

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“…Lowering the practical and logistical barriers to carrying naloxone ( 20 ) could save additional lives. Regions with low saturation would benefit the most ( 21 ). The source of naloxone matters, too: Recent modeling analysis suggests that pharmacy standing order- and community-based naloxone distributions are more efficient channels than provider-based distribution ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

et al. 2022

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Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers’ capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.

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Section: Discussionmentioning

confidence: 99%

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

et al. 2022

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“… 9 , 10 , 11 Rhode Island enacted overdose-related laws to remove barriers to naloxone access and rescue, including naloxone dispensation under standing orders, pharmacy-based naloxone access, and Good Samaritan laws. 12 , 13 As of 2021, there were more than 15 agencies providing opioid overdose education and naloxone distribution (OEND) programs across Rhode Island, 14 each servicing distinct population groups at different risks for opioid overdose in different communities. Naloxone distribution through each of these programs may require different levels of resources and may have different levels of effectiveness in reducing OODs.…”

Section: Introductionmentioning

confidence: 99%

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

et al. 2022

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ImportanceIn 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations.ObjectiveTo compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs).Design, Setting, and ParticipantsIn this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island.InterventionsDistribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach).Main Outcomes and MeasuresWitnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates.ResultsA total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo.Conclusions and RelevanceIn this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.

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“…First, the form of the pharmacy data required aggregation to the 3-digit ZIP area. Smaller geographic areas may have provided us more information with which to detect an effect of naloxone, and understanding the community-level distribution of naloxone and overdose mortality is critical to inform targeted, community-based naloxone distribution strategies ( Zang et al, 2021 ). This effect may be exacerbated by our use of quarter-year, which is broad time measure.…”

Section: Discussionmentioning

confidence: 99%

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

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Jalali

et al. 2022

Drug and Alcohol Dependence Reports

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Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island

Cited by 20 publications

References 38 publications

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

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